PERSONEL DATA FORM

Note : No. : ............................................

a. Fill in with BLOCK LETTERS
b. Fill in with cross mark (X) for the chosen answer

I. IDENTITY
Full Name : ZULFRIDEN SIREGAR Nickname :FRIDEN
Place & Date of Birth : BESITANG
Sex : Male Female

Address : JLN. PERJUANGAN 1 KEL.SEPINGGAN BARU BALIKPAPAN SELATAN, BALIKPAPAN

City : BALIKPAPAN HP : 087888845954 Ph : -
Office Address : UNIT A1 BUSINES CENTRE BARONG TONGKOK KAB. KUTAI BARAT
City : BARONG TONGKOK HP : - Ph : -
Nation : INDONESIA
Email : zulfriden.siregar007@gmail.com
Social Media Account : Instagram : -
Twitter :-
Facebook : ZULFRIDEN

II. EDUCATIONAL BACKGROUND

1. Formal Education
Name of School Major Time Period GPA
J.H.S SMP N.1 BABALAN IPA 2002-2005 25.57
S.H.S SMA N.1 GEBANG IPA 2005-2008 34.47
ACADEMY
UNIVERSITAS
S-1 KEHUTANAN 2010-2017 2.99
SUMATERA UTARA
S-2
S-3

2. Informal Education (Course / Training)

No Type of Course / Training) Place Time Period Comments
1 Pengawas Operasional Pertama Barong Tongkok Des 2022 Lulus
2 Pengelolaan Limbah B3 Online Zoom Feb 2023 Lulus
3
4
5

3. Foreign Language
Oral Written
No Language
Poor Fair Good Poor Fair Good
1 English
2
3

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III. FAMILY STATUS
1. Marital Status : S S Single Engaged since ................ Married since Des 2021

2. Immediate Families
Name M/F Place & date og birth Education
Wife KRISTINA SINAMBELA F BALIGE, 22/01/1991 D III - KEBIDANAN
1st Child
2nd Child
3rd Child

3. Surbfamily members (Kinship)

Name M/F Place & date of birth Education
Father ANGGIAT SIREGAR M SIDIKALANG, SMA
25/05/1953
Mother KALARA BR. MANALU F SIDIKALANG, SMA
09/02/1959
1st Child FALENTINA SIREGAR F SIDIKALANG, D3
18/12/1978
2nd Child ANDI SIREGAR M SIDIKALANG, S1
26/07/1980
3rd Child PONIMAN SIREGAR M SIDIKALANG, D3
04/05/1982

4. Transportation

Car Motorcycle Public Transportation

IV. OCCUPATIONAL BACKGROUND

1. Work Experience
Number of
No Company Period Position Last salary Reason for leaving
Subordinate
1 PT FAJAR SURYA 2018-2021 HSE STAFF ENVIRO 6000000 DAPAT KERJA
SWADAYA STAFF BARU
2 PT MANOOR BULATN 2021 - ENVIRO ENVIRONM 11000000 MASIH BEKERJA
LESTARI SEKARANG SUPERVISOR ENT SPV
3
4
5

2. Explain your main job for each position above.

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3. Mention some improvement you have implemented in your area of responsibility

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4. Describe the biggest problem you faced. How did you handle them ?
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5. Please explain an example of good decision you have made in the last six month ? What were the alternatives ?
Why you choose that decision ?
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6. What do you like most about your present job / position ? (Condition, tasks, or assignment) Why ?
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7. What do you like least about your present job / position ? (Condition, tasks, or assignment) Why ?
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8. Why did you choose this career (type of work) ?

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9. Please give some example of experiences in your job that were satisfied & unsatisfied
Satisfied experience Unsatisfied experience
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V. INTEREST & EXPECTATION

1. What are your career goals for the next five years ? What have already you done to accomplish them ?
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2. What are your reason for leaving your present position ?

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3. Expected Salary Rp. __________________________________

4. Other facilities _____________________________________________________________________________________

5. Please rank 3 job fields that you interest most.

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6. Do you have any objection being assigned out of Jakarta ? Yes No

VI. SOCIAL ACTIVITIES

1. Sport : _____________________________________________________________________________________________

Hobbies : _____________________________________________________________________________________________

2. Organization :
No Organization Place Position Period
1
2
3

3. References
Name Address & Phone No. Relationship

VII. O T H E R S

1. What would be your strong point ?

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2. What should be considered need improvement ?

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3. Have you ever been hospitalized in the last 2 years ?

No Kind of disease Period Effect
1
2

I certify that the information contained in this personal data form is true and accurate.

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Signature

( _____________________________ )

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